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NPI Code Detail

MEDICARE: HEATHER M DEREUS MD

MEDICARE: HEATHER M DEREUS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME175107FL

General Provider Information

NPI Number : 1639812522
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER M DEREUS MD
Provider Business Mailing Address
First Line : 2855 5TH AVE N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33713-6701
Country : US
Telephone Number : 727-323-2727
Fax Number : 727-327-8101
Provider Business Practice Location Address
First Line : 2855 5TH AVE N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33713-6701
Country : US
Telephone Number : 727-323-2727
Fax Number : 727-327-8101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2022
Last Update Date : 02/18/2026

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Directions to “ HEATHER M DEREUS MD” Practice Location

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